Selective mutism

Selective mutism is a childhood anxiety disorder where a child who can speak normally in some settings becomes unable to speak in others, such as at school or in public. It primarily affects the communication system and is linked to extreme social anxiety. Children with this condition often understand language and want to speak but feel physically unable to do so in certain environments. This can lead to difficulties in social interactions, academic performance, and emotional development. The condition usually begins before age 5 but may not be recognized until the child starts school. It is important to note that the child is not choosing to be silent but is experiencing a psychological block. The disorder can persist if untreated, impacting the child's overall well-being and social growth.

Selective mutism is a complex childhood anxiety disorder characterized by a consistent failure to speak in specific social situations despite speaking normally in others. It is considered a form of social phobia with a core pathology involving extreme anxiety and fear of social embarrassment or negative evaluation. The condition typically manifests before age 5 and is associated with behavioral inhibition and temperamental predisposition. The mutism is not due to lack of knowledge or comfort with the spoken language, nor is it caused by a communication disorder or developmental delay. It is important clinically because it can severely impair social functioning and academic achievement. The underlying mechanism involves heightened amygdala activation and avoidance behaviors triggered by social stressors. Diagnosis requires careful differentiation from other causes of speech absence such as autism spectrum disorder or hearing impairment.